Initial view on the Future of Health from the Future Agenda programme

1. Dr Jack Lord
CEO, Navigenics Inc.
Future of Health
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2. The Global Challenge
The world is a connected and shrinking place - and whilst we all are connected - the global issues for health Between now
are both dissimilar but connected! How so? I see three major challenges: and 2020 we are
likely to see
somewhere
Firstly, between now and 2020 we are likely to see corresponding investment in prevention and health. between 2 to 3
somewhere between 2 to 3 global pandemics. Several The industrial age model of treating disease in hospitals global pandemics.
years ago the pandemic of Avian flu began in Asia; or other high intervention settings has almost a “nuclear
today the world faces the Swine flu that can be traced arms” like pace of investment that outstrip any evidence
back to central and south America. And tomorrow? In of improved productivity or quality of life. So issue
general these pandemics arise in areas that do not number two: “The world is older, sicker and fatter” than
have the top tier of preventative or public health it has ever been.
infrastructure and, from there, spread to the advanced
We are victims of our own success. By successfully
Western countries. And our ability to achieve global
“rooting out” the causes of death and at least deferring
bio-surveillance for disease is limited because of
death, we have ended up in a spot with far more people
unequal infrastructure, inadequate local investments
living into age bands that the world hasn’t had
and only limited global cooperation. So issue number
experience before. Consider this - today there are more
one is bio-surveillance and adequacy of public
people living over the age of 65 than ever have before
health infrastructure.
in the entire history of the world! How do we adjust to
This raises the age-old social questions about new roles for people in these age bands? How do we
re-distribution of wealth from the richest nations to the engage their minds so that they remain active and
poorest ones. Perhaps this is the decade that it will contributing in the face of age related changes? What
occur? If “enlightened self-interest” is a driver of are the new rules for work, retirement, and “family”?
behaviour, then in a world with airplanes, ships, and What do our communities need to look like? And
dependencies on global sourcing for food, it seems only stepping beyond that the “rules” of history around work,
logical to attack the pre-existing conditions that give exercise, food and natural resources are turned upside
rise to pandemic and invest in the infrastructure to track down. In a world where we used to get paid for
and treat. Of the issues the “answer” is the easiest of physical work, we now pay to go to gyms to work out!
the global challenges - the question is “is there a will to We have created incredible productivity for relatively
do this?” cheap food and have been super sized as a result! And
today we pay more for water than we do for petrol. So,
Secondly, for the industrialized world from the United
issues like behavioral change, social policies around
States to Europe to Japan the cost burdens of
obesity and personal responsibility for health, public
healthcare in the face of demographic shifts (aging),
investment in programs to prevent illness through a
increasing rate of chronic illness and related pre-cursor
variety of means are all questions in an incredibly
conditions (eg obesity) present enormous systemic
complex situation.
challenges. The increasing cost of these effects
government and personal budgets but has failed to Thirdly, the role of healthcare as an important part of
provoke a change in approach. The context of these the economic infrastructure is often overlooked.
systems is a cultural “more is better” attitude to the Balancing investments in new technologies, prevention,
investment in treatment of illness without a healthcare related Information Technology with existing
Future of Health 55

3. What do you think? Add your views to the global perspective on www.futureagenda.org
China, India and labor intense processes present a challenge. The and the other around the process of discovery. On
the Middle East balancing is complex in and of itself, so high provisioning, when will the industry join the “information
are all seeing
spikes in the rates
expenditure already does not guarantee a high level of age”, how will it rethink the labor and productivity
of diabetes, heart quality. Above and beyond this whilst almost every related challenges, and how and who will provide
disease and industrialized country has undertaken some approaches prevention services? Embedded in this discussion is the
obesity. It is an
to healthcare reform, none have tackled the entire transition from a “sick care” system to a “health
inevitable march
that seems to be fundamental economic questions about healthcare, the care” system. The investment in discovery will parallel
associated with healthcare workforce, and healthcare investment. This that transition - from “thermonuclear war” against death
affluence and a issue needs to be contextualized to the other societal to the aspirational march to improving health and the
knowledge based
investments that need to be made in education, quality of life. How do government policies need to
economy.
sustainability and infrastructure. So issue number three change to re-prioritize these investments? How does
is the ‘right’ amount of healthcare to spend as a government thinking need to move from “budgeter” to
percentage of GDP. “risk manager”? And how do new discoveries around
genetics, probabilistic medicine and regeneration
There are two tracks here: One related to the
influence the balance of prevention vs. treatment?
revamping of the provisioning of health care services
Options and Possibilities
As the old saying goes “nothing is certain but death and taxes”. But the pandemic of chronic illness and
obesity is about as certain as one could come too. And that certainty isn’t only for the developed world; it
appears to be certain for the developing world as well: China, India and the Middle East are all seeing spikes
in the rates of diabetes, heart disease and obesity. It is an inevitable march that seems to be associated with
affluence and a knowledge based economy.
There is a reasonable level of certainty to the waves of has greater demands. On discovery, high probability of
infectious pandemics - what is not clear is the source a “fly” wheel effect for new diagnostic and therapeutic
and vectors. But given history, these diseases seem interventions; a questionable appetite to rebalance and
to follow a wave form and become generally more invest in prevention
complex to treat and eradicate.
There are two paths that need to be worked in parallel.
On the provisioning of health care, inertia seems to be A holistic view of what needs to change for the twenty
the greatest force. Whilst there are many great first century and a geographically focused bottom up
discussions of healthcare reforms, the betting man for reforming healthcare systems.
would need to say that the problems as they exist today
will only grow as budgets get leaner and the population
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4. Holistically the possible changes that need to be one where a balanced research investment - disease In an ideal world
considered include; the move from a sick-care system and prevention. In parallel with this, we can choose to the organizations
responsible for
to a healthcare systems accompanied by a shift from a migrate from provincial mindsets of health systems to a global health
passive view to health to a more active view to co- more global view of health and disease, and move from would move from
creating health. At the same time we could change a professional driven system to a popular frame of their marginalized
roles to a lead
from conducting research to treat disease primarily to consumer driven health.
role on the public
stage.
Proposed Way Forward
Given the three main issues of improving bio-surveillance and adequacy of public health infrastructure; dealing
with a world that is older, sicker and fatter than it has ever been; and, at the same time, determining the “right”
amount of healthcare spend as a percentage of GDP, we have some pretty substantial challenges to address.
However, as outlined above, we also have a number of alternatives available to us. So what is the best
path forward?
Many would now agree that, from the bottom up, with subsequent strategies for mitigating or eliminating
individual health economies need to undertake risk; leveraging the emerging power of science that
assessments of future risk and management of future allows us to predict future health and take organized
health inflation. In addition, we need to establish public steps to prevent illness; creating a global approach to
policy forums around entitlement to health, sharing sharing best practices, standards for information
risks, personal responsibility, and basic health access technology platforms; leveraging technologies to
vs. specialized healthcare services. The exploration of improve bio-surveillance and; providing education and
the utility and impact of social media, transparency of access to social media resources that enable people to
information and incentives and rewards for healthy better co-create their own health as opposed to being
behaviors is another one on the ‘to-do’ list. On top of dependent on a sick-care system or be subject to
that we should review the effectiveness of bio- environmental influences that they are completely
surveillance programs and undertake strategic planning unaware about.
for the role of the healthcare industry in context of
domestic economies
I see that in an ideal world the organizations responsible
for global health would move from their marginalized
roles to a lead role on the public stage. From that
stage, the items that need to be addressed include;
looking at population health from a risk managers view
Future of Health 57

5. What do you think? Add your views to the global perspective on www.futureagenda.org
Impacts and Implications
The next decade While progress could be achieved from quickly addressing the key challenges, unfortunately the most likely
is not likely to be outcome is one that results from inertia The next decade is not likely to be the time for change, but instead
the time for
change, but
a time that “stressors” on the system become progressively evident. The march of increased burdens of
instead a time that demography and chronic illness will remain unabated; for industrialized countries the ratio of workers
“stressors” on the contributing to the system compared to the people utilizing government sponsored entitlements will continue
system become
to drop; and international collaboration to prevent illness in underserved regions will likely remain perfunctory.
progressively
evident. Increased The net - net is we will see continuing and rising concerns about health and health care setting up the next
burdens of decade for fundamental change.
demography and
chronic illness will
remain unabated.
While health changes will affect and be affected by And we tend to think that the way to reduce health
developments outside in such areas as food, costs is to beat down the supply of care, when we really
technology, housing, public policy and financing, the need to invest in preventive strategies today that will
core implications are clear. Each of the issues discussed reduce the future demand for care. The boundary
contains a paradox that challenges our conventional between now and later is permeable.
ideas about how we think about these risks.
To manage these risks we need to get beyond the
To protect ourselves from rogue infections on our own binary thinking. Between this and that, between us and
shores, in today's interconnected world we may have to them, between you and me, between now and later,
think about investing in a global public health there is an infinity of intimate connections that we can't
infrastructure abroad. The boundary between us and ignore and we can't break. We can't choose between
them is permeable. personal behavior and social responsibility. It has to be
both because our personal behavior has social
We tend to view our personal health behaviors as
consequences. We can't choose between reducing
personal and not really anybody else's business but our
health costs and investing in health promotion - it has
own, and yet the diseases that issue from our indolence,
to be both or we won't have either. We need a new kind
gluttony, and addictions to tobacco and alcohol are
of thinking for the pursuit of health.
going to be financed by those of us who chose to
exercise, eat sensibly, and shun smoke and drink. The
boundary between me and you is permeable.
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6. We can't choose
between reducing
health costs and
investing in health
promotion - it has
to be both or we
won't have either.
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